Informed Consent to Treatment Health Philosophies and Ethics

Informed Consent to Treatment Throughout Canada, before health care professionals may treat a client, he or she requires the informed consent of the client. The health care professional must determine whether the person is capable of giving consent to treatment. The individual’s capacity to give consent can change. One day they may be capable, the next, incapable. If a person becomes incapable (unable to understand the nature of an intervention), the issue of consent must be readdressed. Consent MUST be both Informed and Voluntary.

Informed Consent Informed Consent is based on the patient understanding: 1) the treatment or procedure 2) the nature and purpose of the proposed treatment 3) risks, side effects, benefits and expected outcomes 4) implications of refusing recommended treatment 5) be made of alternatives (if any) to the proposed treatment so they understand their choices *Health care professionals have an obligation to use language that is at an appropriate level and to discuss the information when the client is not stressed or unhappy (may require second explanations of the intervention when the client is in a calm frame of mind)

Voluntary Consent: Clients must NOT feel compelled to make a decision for fear of criticism, nor must they feel pressured toward any particular decision by the information provider or anyone else. *At times only a fine line exists between coercing (i.e., bullying) and making a recommendation especially when the health care professional feels strongly that the client should consent to a treatment, and the client is leaning toward refusing it. *According to the Supreme Court of Canada, it is the basic right of every capable person to decide which medical interventions he or she will accept or refuse. It shows respect for the client and the person’s right to autonomy; it also improves client compliance with treatment regimes. *Every province has its own legislation regarding informed consent. Health care providers are encouraged to obtain written consent for all medical services even minor medical services like immunizations.

Types of Consent: Written Consent: Major medical interventions require signed, written consent as confirmation that the appropriate process for obtaining consent was followed and that the client has agreed to the intervention. Client must understand the intervention along with the risks and benefits Most forms must be signed by the client, dated and witnessed (the definition of a witness varies in different areas)

Types of Consent: Written Consent (cont’d): For minor or major surgeries, physicians or a registered nurse will usually witness the consent The witness must be sure the client understands what they are signing. If there is doubt, there must be further explanation and clarification. Most hospitals have a list of volunteer interpreters should the need arise, but interpreters who can deliver health-related information clearly and accurately are not always available. Often family members translate and what is presumed to be “informed consent” may not be.

Types of Consent: Oral Consent: Given by spoken word over the phone or in person and is as equally binding as written consent At times, someone other than the client offers consent to surgery Two people must validate that consent has been given Written consent is still preferred for complex treatments

Types of Consent: Implied Consent: Consent assumed by the client’s actions, such as seeking out the care of a health care professional or failure to resist or protest. More and more health care professionals are requesting written consent even for treatments within a health clinic (e.g., receiving immunizations at the clinic). By allowing themselves to be admitted into a hospital, clients imply their consent to certain interventions (e.g., allowing the nurse to give them a bath or take vital signs). However, where possible oral consent should be obtained. “Is it okay if I change your dressing in a little while?” *Refusal to treatment are recorded on health records with reasons for refusal provided by the client*

Who Can Give Consent The person receiving medical care most often gives consent for treatment If the person is incapable of providing consent (e.g., is unconscious or not mentally competent), the person’s legal representative or next of kin assumes the responsibility. The person who has power of attorney (A legal document naming a specific person or persons to act on behalf of another in matters concerning personal care, personal estate or both) may take on this duty. If no power of attorney is present, most provinces and territories will allow a spouse (legal or common law) or another family member to legally provide consent. In some locations, there is a designated order depending on the availability of particular relatives – typically, a spouse will have control before a mother and father who have control before a sibling, then aunts and uncles and so on.

In most regions, there is no specific age defining a minor (a person under the age of majority in a particular province or territory) when it comes to providing independent consent to treatment or to requesting treatment without a parent’s knowledge. As long as the minor fully understands the treatment (along with risks and benefits), he or she can make an informed decision about accepting or rejecting treatment, and health care professionals MUST respect his or her wishes. When a minor’s consent is accepted, the minor is referred to as a mature minor. Frequently, a minor’s consent to treatment is made along with the parents. Emancipated minors – those married, living on their own, or showing independence from parents in some way – may also consent to medical care. When required, either parent with legal custody of the minor (or legally appointed guardian) can provide consent to treatment. **In the view of the courts, if the children are too young to hold and express beliefs or understand the consequences of receiving or not receiving treatment, courts will uphold requests made to intervene on the child’s behalf.